Nurse performance in hospital financial auditing: a single case study

Abstract

Objective: To analyze the performance of nurses in retrospective financial audits, compared with that of “non-nurses”, for remuneration of a hospital by supplemental health insurance providers. Method: A single, quantitative, retrospective, documentary and analytical case study, using as the unit of analysis a set of 238 accounting bills invoiced by “non-nurses” and audited by nurses for outpatient procedures in the hemodynamics service of a public hospital in the state of São Paulo, from 2019 to 2021. Results: Underbilling was detected in 100% of the billing groups in the “billed < audited” category, regardless of the procedures performed, with a cumulative total of R$ 1,024,692.00, which, updated to September 2024, would correspond to R$ 1,344,125.00. In cases of undue charges, “billed > audited”, there was a cumulative total of R$ 647,828.00. Conclusion: Retrospective financial audits performed by nurses increase hospital revenue. Finally, this study contributes by demonstrating the need to train these professionals in economic and financial skills in health care, highlighting the importance of the emerging role of financial auditor nurses in the health care market.